Journal article
The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration.
- Afferi L Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
- Zamboni S Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
- Karnes RJ Mayo Clinic Urology, Rochester, MN, USA.
- Roghmann F Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
- Sargos P Department of Radiation Oncology, Jewish General Hospital, McGill University Health Centre, Montreal, Canada.
- Montorsi F Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
- Briganti A Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
- Gallina A Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
- Mattei A Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
- Schulz GB Urologische Klinik Und Poliklinik, Klinikum Der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.
- Hendricksen K Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Voskuilen CS Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Rink M Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Poyet C Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
- De Cobelli O Division of Urology, European Institute of Oncology, Milan, Italy.
- di Trapani E Division of Urology, European Institute of Oncology, Milan, Italy.
- Simeone C Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
- Soligo M Mayo Clinic Urology, Rochester, MN, USA.
- Simone G Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
- Tuderti G Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
- Alvarez-Maestro M Department of Urology, La Paz University Hospital, Madrid, Spain.
- Martínez-Piñeiro L Department of Urology, La Paz University Hospital, Madrid, Spain.
- Aziz A Department of Urology, München Klinik Bogenhausen, Munich, Germany.
- Shariat SF Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
- Abufaraj M Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
- Xylinas E Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.
- Moschini M Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. marco.moschini87@gmail.com.
- 2020-05-02
Published in:
- World journal of urology. - 2020
Bladder cancer
Clinical metastases
Induction chemotherapy
Multimodal treatment
Radical cystectomy
Urothelial cancer
English
PURPOSE
To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status.
METHODS
A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality.
RESULTS
Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003).
CONCLUSION
Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status.
METHODS
A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality.
RESULTS
Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003).
CONCLUSION
Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00345-020-03205-z
- PMID 32356226
- Persistent URL
- https://sonar.ch/global/documents/298702
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